2015年四川省儿童患者病原菌分布与耐药性监测

摘要

目的 分析2015年四川地区儿童患者病原菌的分布及药敏情况.方法 采用仪器结合手工的方法对细菌进行鉴定及药敏实验,并用WHONET5.6软件进行统计分析.结果 四川地区儿童患者病原菌主要来源于痰液(70.6%)、血液(7.7%)及分泌物(6.3%).阳性球菌主要以金黄色葡萄球菌(17.93%)、肺炎链球菌(15.09%)为主,阴性杆菌主要以大肠埃希菌(15.17%)、流感嗜血杆菌(14.51%)及肺炎克雷伯菌(9.68%)为主.全省耐甲氧西林金黄色葡萄球菌(MRSA)检出率是23.2%,未发现万古霉素、利奈唑胺、替考拉宁、替加环素耐药的金黄色葡萄球菌;产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为47.3%和39.4%.流感嗜血杆菌及卡它莫拉菌对三代以上的头孢菌素及喹诺酮类药物比较敏感.屎肠球菌对药物的耐药情况比粪肠球菌严重,耐万古霉素(VRE)的屎肠球菌的检出率达到1.5%,两者都出现对利奈唑胺的耐药株.结论 四川地区儿童患者以呼吸道感染为主,阳性球菌主要是金黄色葡萄球菌和肺炎链球菌,阴性杆菌主要是大肠埃希菌,流感嗜血杆菌及肺炎克雷伯菌.不同地区细菌耐药性有一定的差异,由于儿科用药的特殊性,应加强临床用药指导,合理使用抗生素,防止耐药菌的产生和扩散.%Objective To analyze the distribution and susceptibility of pathogens in pediatric patients in Sichuan province dur -ing 2015 .Methods Bacteria were identified by using the instruments combined with manual method ,and the sensitivity test was car-ried out.The data were analyzed by WHONET5.6 software.Results In Sichuan,the pathogens of sick children came mainly from spu-tum (70.6%),blood (7.7%) and secretions (6.3%).The positive cocci were mainly Staphylococcus aureus (17.93%) and Strep-tococcus pneumoniae (15.09%).The main negative bacteria were Escherichia coli (15.17%),Haemophilus influenzae (14.51%) and Klebsiella pneumoniae (9.68%).The detection rate of MRSA in the whole province was 23.2%.No vancomycin,linezolid,teico-planin and tigecycline-resistant Staphylococcus aureus were found .The detection rates of ESBLs-producing Escherichia coli and Kleb-siella pneumonia were 47.3%and 39.4%,respectively .Haemophilus influenzae and Moraxella catarrhalis were relatively sensitive to the third generations of cephalosporins and quinolones .The resistance to drug of Enterococcus faecium was more serious than Enterococ -cus faecalis.Enterococcus faecium (VRE) detection rate was 1.5%.There were linezolid-resistant strains in both of Enterococcus fae-cium and Enterococcus faecalis .Conclusion Respiratory infection is the main cause of sick children in Sichuan .The positive cocci are Staphylococcus aureus and Streptococcus pneumoniae .The main negative bacteria are Escherichia coli , Haemophilus influenzae and Pneumoniae .There is a difference in bacterial drug resistance in different area .Due to the particularity of pediatric drug use ,we should strengthen the guidance of clinical medication and rational use of antibiotics to prevent the emergence and spread of resistant bacteria .